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Utah rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Facilitymedian $2 · 10th–90th $2$60%50%90th$2Professionalmedian $7 · 10th–90th $2$430%10%10th90th$7$0.1$0.5$2.0$10.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $6.31 / $42.66
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $6.92
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $7.24 / $9.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $7.08 / $10.96
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.77 / $9.77 / $10.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.59 / $10.00 / $12.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.31 / $3.80 / $4.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.31 / $4.17 / $7.59